Wisconsin Office of the Secretary of State
Annexation/Detachment Ordinance Checklist and Submittal Form
Section 1
Annexed Land Location
Municipality Name
County Name(s)
Village or
City
(Annexor):
Municipality Name(s)
(Annexee):
Section 2: Type of Land Transfer
Type 1 Annexation by Unanimous Approval, One-half Approval, or Referendum
Type 2 Annexation by City or Village Initiated Referendum
Type 3 Annexation of Town Islands
Type 4 Annexation of Territory Owned by a City or Village
Type 5 Detachment
Type 6 Annexation resulting from s. 66.0225 judicial stipulation and order
Type 7 Annexation or Attachment resulting from s. 66.0301 Boundary Agreement
Type 8 Annexation or Attachment resulting from s. 66.0307 Boundary Agreement
Annexation Petitions by Unanimous or One-Half approval require review
by the Wisconsin Department of Administration (DOA) for land in counties
having a population greater than 50,000.
Municipal Boundary Review (MBR) Number assigned by DOA:
Ordinance Enactment Date
Section 3: The following items are required for a complete submission. Check these
items if included. If not included, the ordinance will be returned to the submitting
municipality to obtain the missing information.
Plat (a scale map)
Complete Legal Description
Parcel Number(s), if available (if only part of a tax parcel is being annexed, state the
number of that parcel)
Certification of documents with original signature
Population: List the number of all people living on the annexed land below. If
annexing from more than one municipality, list population for each affected municipality
Municipality Name
County
Population
(Form updated on June 2010)
See the next page if you have questions about the information on this form.
Annexation/Detachment Ordinance Checklist and Submittal Form Instructions
Please do not submit these instructions when submitting ordinances.
Section 1
 Check the appropriate Village or City Box, record the municipality name and county
location of the transferred property. If property is in more than one county, list each
county.
 Record the full name of municipality having property annexed or detached (i.e. City,
Village, or Town of__________) and County
Section 2
 Check the appropriate box for the type of property transfer. Type 1 transfers are
initiated by property owners, Type 2 through 6 transfers are initiated by
municipalities. Type 3 transfers are rarely used. When a lawsuit has been settled by a
stipulation and order, or boundary agreements have been adopted by municipalities,
Type 1 and Type 6-8 boxes are usually checked. For Detachments, the municipality
receiving the property is the “Annexor” and the municipality losing the property is
the “Annexee” Statutory references for these transfers are provided below.
 When requested, DOA also reviews annexation petitions in counties having
population less than 50,000. Please record the MBR number anytime you know that
an MBR review has been completed.
 Record the date your municipality approved the ordinance.
Section 3
 Use the checklist to ensure you have included all of the material our office must have
before the ordinance can be accepted. Verify that the scale map includes a scale on
the face of the map.
 If only part of a tax parcel is being annexed, state the number of that parcel.
 Fill in the population of the transferred property being sure to list population that is in
each municipality when more than one municipality is involved.
Wisconsin State Statute References
66.0217 Annexation initiated by electors and property owners
66.0217(9) Filing requirements; Surveys
66.0219 Annexation by referendum initiated by city or village
66.0221 Annexation of and creation of town islands
66.0223 Annexation of territory owned by a city or village
66.0225 Stipulated boundary agreement in contested boundary actions
66.0227 Detachment of territory
66.0301 Intergovernmental cooperation
66.0307 Boundary change pursuant to cooperative plan
Further Information:
Annexation Ordinances: Phil Wells, 608-266-1927, Philip.Wells@wisconsin.gov
Demographic Services Center, Department of Administration
Annexation Petitions: Erich Schmidtke, 608-266-3200 Erich.Schmidtke@wisconsin.gov
Municipal Boundary Review, Department of Administration
Office of the Secretary of State: 608/266-8888, statesec@sos.state.wi.us